Teaching Zambian traditional birth attendants to monitor growth of infants : evaluation of an education program

The high infant mortality in Zambia is largely attributable to malnutrition. It is exacerbated by the inability of mothers to recognise threats to nutritional status and take corrective action. Advice in ‘Health Centres’ is often inaccessible to mothers. The Traditional Birth Attendants (TBAs) work with pregnant women in local communities, and the purpose of this study was to develop and implement an educationprogram in growth monitoring and nutrition for the TBAs and then to evaluate its effects. Twenty five TBAs from two peri-urban areas of Kitwe were enrolled in this pilot study and eighteen completed the program. The researcher developed and taught a program to the TBAs over ten days. A pretest was given before the teaching program to enable the researcher to obtain information about the knowledge and skills of the TBAs. Following the teaching program the TBAs were re-tested, with the same questionnaire. Focus groups were conducted to enable the TBA to provide information on the teaching materials and the education program. The TBAs then returned to their communities and put into practice the skills and knowledge they had learned for six months. Their practice was monitored by a trained Public Health Nurse. The researcher also surveyed 38 pregnant women about their knowledge of growth monitoring and nutrition before the TBAs went into the field to work with their local communities. The same questionnaire used with the pregnant women was administered to 38 new mothers with children aged 0 to 6 months to gain information of their knowledge and skills following the work of the TBAs. The program was evaluated by assessing the extent to which TBAs knowledge and skills were increased, the knowledge and understanding of a selection of their clients and the rates of malnutrition of infants in the area under study. The results from the research clearly indicated that the teaching program on growth monitoring and nutrition given to the selected group of TBAs had a positive effect on their knowledge and skills. It was found that the teaching developed their knowledge, practical skills, evaluative skills. That they were able to give infants’ mothers sound advice regarding their children’s nutrition was revealed by the mother’s increased knowledge and the decrease in numbers of malnourished children in the study areas at the conclusion of the research. The major outcomes from the study are: that Zambian TBAs can be taught to carry out an expanded role; field experience is a key factor in the teaching program; making advice available in local communities is important; and preliminary data on the Zambian experience were generated. Recommendations are: The pilot program should be expanded with continuing support from the Health Department. Similar educational programs should be introduced into other areas of Zambia with support from the Ministry of Health. That in administering a teaching program: Sufficient time must be allocated to practical work to allow poorly educated women to attain the basic skills needed to master the complex skills required to competently reduce faltering in their communities. The teaching materials to illustrate nutritional principles for feeding programs must be developed to suite locally available foods and conditions. Methods of teaching should suit the local area, for example, using what facilities are locally available. The timing of the teaching program should be suitable for the TBAs to attend. This may vary from area to area, for example it may be necessary to avoid times traditionally given to fetching water or working in the fields. For similar reasons, the venue for the teaching program should be suitable to the TBAs. The teachers should go into the TBAs’ community rather than causing disruption of the TBAs’ day by expecting them to go to the teacher. Data should be collected from a larger group of TBAs and clients to enable sophisticated statistical analysis to complement data from this pilot program. The TBAs should be given recognition for their work and achievement. This is something which they asked for. They do not ask for payment, rather acknowledgment through regular follow up and approbation.

Vigorous exercise and birth outcomes in a sample of recreational exercisers : a prospective study across pregnancy

Objective: This study examined the question of whether vigorous exercise undertaken by recreational exercisers across pregnancy, defined in two ways, were associated with reduced infant birthweight and gestational age at birth.

Methods: A prospective approach was implemented. A total of 148 pregnant women participated. Average intensity duration and frequency of vigorous exercise reported were examined and compared with two existing definitions of vigorous exercise. Participants completed questionnaires (including retrospective reports on 3 months prepregnancy) and an exercise diary at 16–23 weeks pregnancy, 24–31 weeks pregnancy and 32–38 weeks pregnancy, and at 7 to 14 days post-partum a birth outcomes questionnaire was completed.

Results: There were no significant differences between exercise groups for birthweight and gestational age at birth.

Conclusions: There was no evidence that the intensity duration and frequency of vigorous exercise were associated with significant reductions in mean birth outcomes for the infants of women who participated in the study. Replication in a large, more diverse sample is recommended.

Prelude to the birth of Wayo-Secchu (Japanese hybrid style) in Japanese early modern architecture

This paper will investigate the background of the emergence of Wayo-secchu (Japanese Hybrid Style), by re-examining the rhetoric of the government-oriented early Meiji Western style architecture and Japanese traditionalism's reaction to it. I will elucidate the undercurrent of the intentional shift in nineteenth-century Japan towards the recuperation of traditional Japanese style, a shift which initiated the Japanese hybrid style we now call Wayo-secchu. I will discuss the effect of institutional pressure to Westernize, by investigating what was meant by a new architectural method as expressed by the government of the time.

Duly delivered : women's experiences of birth planning

Critically examines the construct of power differentials in the childbirth experiences of forty-two women following the birth of their first child. Detailed data was collected using questionnaires and in-depth interviews with women from a range of localities around the State. The research demonstrated that childbirth processes in Victoria effectively ignore the wishes of pregnant women leading to them suffering significant physical and psychological health consequences.

Birth of a biome : insights into the assembly and maintenance of the Australian arid zone biota

The integration of phylogenetics, phylogeography and palaeoenvironmental studies is providing major insights into the historical forces that have shaped the Earth’s biomes. Yet our present view is biased towards arctic and temperate/tropical forest regions, with very little focus on the extensive arid regions of the planet. The Australian arid zone is one of the largest desert landform systems in the world, with a unique, diverse and relatively well-studied biota. With foci on palaeoenvironmental and molecular data, we here review what is known about the assembly and maintenance of this biome in the context of its physical history, and in comparison with other mesic biomes. Aridification of Australia began in the Mid-Miocene, around 15 million years, but fully arid landforms in central Australia appeared much later, around 1–4 million years. Dated molecular phylogenies of diverse taxa show the deepest divergences of arid-adapted taxa from the Mid-Miocene, consistent with the onset of desiccation. There is evidence of arid-adapted taxa evolving from mesicadapted ancestors, and also of speciation within the arid zone. There is no evidence for an increase in speciation rate during the Pleistocene, and most arid-zone species lineages date to the Pliocene or earlier. The last 0.8 million years have seen major fluctuations of the arid zone, with large areas covered by mobile sand dunes during glacial maxima. Some large, vagile taxa show patterns of recent expansion and migration throughout the arid zone, in parallel with the ice sheet-imposed range shifts in Northern Hemisphere taxa. Yet other taxa show high lineage diversity and strong phylogeographical structure, indicating persistence in multiple localised refugia over several glacial maxima. Similar to the Northern Hemisphere, Pleistocene range shifts have produced suture zones, creating the opportunity for diversification and speciation through hybridisation, polyploidy and parthenogenesis. This review highlights the opportunities that development of arid conditions provides for rapid and diverse evolutionary radiations, and re-enforces the emerging view that Pleistocene environmental change can have diverse impacts on genetic structure and diversity in different biomes. There is a clear need for more detailed and targeted phylogeographical studies of Australia’s arid biota and we suggest a framework and a set of a priori hypotheses by which to proceed.

Neonatal growth outcomes at birth and one month postpartum following in utero exposure to antidepressant medication

Objective: There is evidence of increasing prescription of antidepressant medication in pregnant women. This has arisen from the recognition of the importance of treating maternal depression. This must be balanced, however, with information on outcomes for infants and children exposed to antidepressants in pregnancy. The aim of the present study was to examine whether neonatal outcomes including gestational age at birth, neonatal growth outcomes at birth and then at 1 month postpartum were altered by in utero exposure to antidepressant medication using a prospective and controlled design.

Method: A prospective case–control study recruited 27 pregnant women taking antidepressant medication and 27 matched controls who were not taking antidepressant medication in pregnancy at an obstetric hospital in Melbourne, Australia. Of the 27 women taking medication, 25 remained on medication in the third trimester. A purpose-designed self-report questionnaire and the Beck Depression Inventory-II were completed in pregnancy, after birth and at one month postpartum. In addition information was collected on exposed and non-exposed infants including Apgar scores, birthweight/length/head circumference and gestational age at birth. Weight/length/head circumference was again collected at 1 month of age.

Results: Infants exposed to antidepressants in utero were eightfold more likely to be born at a premature gestational age, had significantly lower birthweight and were smaller in length and head circumference than non-exposed infants. There was no association between birth outcomes and maternal depression. At 1 month, the difference in weight in the exposed group became significantly greater than the control group.

Conclusion: Antidepressant exposure in utero may affect gestational age at birth and neonatal outcomes independently of antenatal maternal depression. Further studies are needed to examine whether these findings vary according to the type of antidepressant prescribed and follow up growth and development in exposed infants beyond 1 month.

Low and high birth weight as risk factors for obesity among 4 to 5 year old Australian children : does gender matter?

Studies testing whether birth weight and childhood obesity differ by gender are lacking. We aimed to describe the relationship between birth weight and childhood overweight/obesity and investigate the influence that gender has on this relationship among 4 to 5-year-old children. We performed a secondary analysis of an Australian nationally representative cross-sectional study in 4 to 5-year-old children. The main outcome measure was child overweight and obesity. We found that low birth weight (LBW) was associated with lower risk of overweight/obesity among girls at 4–5 years before (OR 0.50, 95%CI 0.32, 0.77) and after adjusting for socio-demographic factors (OR 0.51 95%CI 0.33, 0.80) and ethnicity (OR 0.52, 95%CI 0.33, 0.81) but was not associated with child overweight/obesity among boys before or after adjustment. High birth weight (HBW) was associated with a higher risk of overweight/obesity among both girls (adjusted OR: 1.76, 95%CI 1.12, 2.78) and boys (adjusted OR: 2.42 95% CI 2.06, 2.86). Conclusion: There are gender differences in the association of birth weight with child overweight/obesity. HBW was associated with a higher risk of child overweight/obesity in boys and girls before and after adjustment for socio-demographic factors. However, LBW was associated with a lower risk of child overweight/obesity in girls but not in boys. These gender differences need to be considered when planning interventions to reduce child overweight/obesity.

Paracetamol use in early life and asthma : prospective birth cohort study

Objective To determine if use of paracetamol in early life is an independent risk factor for childhood asthma.
Design Prospective birth cohort study.
Setting Melbourne Atopy Cohort Study.
Participants 620 children with a family history of allergic disease, with paracetamol use prospectively documented
on 18 occasions from birth to 2 years of age, followed until age 7 years.
Main outcome measures The primary outcome was childhood asthma, ascertained by questionnaire at 6 and 7 years. Secondary outcomes were infantile wheeze, allergic rhinitis, eczema, and skin prick test positivity.
Results Paracetamol had been used in 51% (295/575) of children by 12 weeks of age and in 97% (556/575) by 2 years. Between 6 and 7 years, 80% (495/620) were followed up; 30% (148) had current asthma. Increasing frequency of paracetamol use was weakly associated with increased risk of childhood asthma (crude odds ratio 1.18, 95% confidence interval 1.00 to 1.39, per doubling of days of use). However, after adjustment for frequency of respiratory infections, this association essentially disappeared (odds ratio 1.08, 0.91 to 1.29). Paracetamol use for non-respiratory causes was not associated with asthma (crude odds ratio 0.95, 0.81 to 1.12).
Conclusions In children with a family history of allergic diseases, no association was found between early paracetamol use and risk of subsequent allergic disease after adjustment for respiratory infections or when paracetamol use was restricted to non-respiratory tract infections. These findings suggest that early paracetamol use does not increase the risk of asthma.

Growth restriction before and after birth increases kinase signaling pathways in the adult rat heart

To investigate the mechanisms for the previously reported development of adult cardiac hypertrophy in male rats following growth restriction, the levels of oxidative stress and activation of signaling kinases were measured in the left ventricle (LV) of adult rat offspring. In experiment one, bilateral uterine vessel ligation to induce uteroplacental insufficiency and growth restriction in the offspring (Restricted) or sham surgery was performed during pregnancy. Litters from sham mothers had litter size either reduced (Reduced Litter), which also restricted postnatal growth, or were left unaltered (Control). In males, Reduced Litter offspring had increased LV phosphorylation of AMPKa, p38 MAPK and Akt compared with Restricted and Controls (P,0.05). In females, both Restricted and Reduced Litter adult offspring had increased LV phosphorylation of p38 MAPK and Akt, however, only Restricted offspring had increased phosphorylation of AMPKa (P,0.05). In addition, only Restricted male offspring displayed LV oxidative stress (P,0.05). Experiment two investigated in mothers exposed to uteroplacental insufficiency or sham surgery the effects of cross-fostering offspring at birth, and therefore the effects of the postnatal lactational environment. Surprisingly, the cross-fostering itself resulted in increased LV phosphorylation of AMPKa and Akt in females and increased phosphorylation of Akt in males compared with Control non-cross-fostered offspring (P,0.05). In conclusion, kinase signaling in the adult LV can be programmed by uteroplacental insufficiency induced growth restriction in a gender-specific manner. In addition, the heart of adult rats is also sensitive to programming following the postnatal intervention of cross-fostering alone as well as by postnatal growth restriction.

Splash!: a prospective birth cohort study of the impact of environmental, social and family-level influences on child oral health and obesity related risk factors and outcomes

Background: Dental caries (decay) is the most prevalent disease of childhood. It is often left untreated and can impact negatively on general health, and physical, developmental, social and learning outcomes. Similar to other health issues, the greatest burden of dental caries is seen in those of low socio-economic position. In addition, a number of diet-related risk factors for dental caries are shared risk factors for the development of childhood obesity. These include high and frequent consumption of refined carbohydrates (predominately sugars), and soft drinks and other sweetened beverages, and low intake of (fluoridated) water. The prevalence of childhood obesity is also at a concerning level in most countries and there is an opportunity to determine interventions for addressing both of these largely preventable conditions through sustainable and equitable solutions. This study aims to prospectively examine the impact of drink choices on child obesity risk and oral health status.
Methods/Design: This is a two-stage study using a mixed methods research approach. The first stage involves qualitative interviews of a sub-sample of recruited parents to develop an understanding of the processes involved in drink choice, and inform the development of the Discrete Choice Experiment analysis and the measurement instruments to be used in the second stage. The second stage involves the establishment of a prospective birth cohort of 500 children from disadvantaged communities in rural and regional Victoria, Australia (with and without water fluoridation). This longitudinal design allows measurement of changes in the child’s diet over time, exposure to fluoride sources including water, dental caries progression, and the risk of childhood obesity.
Discussion: This research will provide a unique contribution to integrated health, education and social policy and program directions, by providing clearer policy relevant evidence on strategies to counter social and environmental factors which predispose infants and children to poor health, wellbeing and social outcomes; and evidence-based strategies to promote health and prevent disease through the adoption of healthier lifestyles and diet. Further, given the absence of evidence on the processes and effectiveness of contemporary policy implementation, such as community water fluoridation in rural and regional communities it’s approach and findings will be extremely
informative.

Data obtained from the health in pregnancy and post birth study

Data is being obtained via a randomised controlled trial to measure the efficacy of specialised health coaching intervention designed to prevent excessive gestational weight gain and postpartum weight retention among women.

The study will collect data via a self-report questionnaire (available in hardcopy and online) at 5 time points across pregnancy and post-birth, including Pregnancy (16 -32 weeks gestation) and Postpartum period (6 weeks to 12 months post-birth). Objective measures are obtained by researchers in a consulting room in a clinic room within a hospital antenatal clinic. Hospital records are also accessed via the Bed Optimization System (BOS). Data obtained includes: demographic information (e.g., education, income), objective measures of height, weight and waist circumference, healthcare resource use general distress and psychopathology (stress, anxiety, depression), exercise and dietary habits, motivation/readiness to change, body dissatisfaction, labour experiences and birth outcomes.

Maternal 25-Hydroxyvitamin D and parathyroid hormone concentrations and offspring birth size

Context: There is inconsistent evidence that maternal 25-hydroxyvitamin D [25-(OH)D] deficiency may impair fetal growth.

Objective: The objective of the study was to examine the relationship between maternal 25-(OH)D and PTH concentrations at less than 16 and 28 wk gestation and offspring birth size.

Design: This was an observational study.

Setting: The study was set at a hospital antenatal clinic.

Participants: Women with singleton pregnancies, before 16 wk gestation, participated.

Interventions: No interventions were used.

Main Outcome Measure: Knee-heel length at birth was the main outcome measure.

Results: Altogether 374 of 475 (79%) women completed this study. We found no evident relationship between birth size measures and maternal 25-(OH)D or PTH at recruitment (∼11 wk). Gestation length was 0.7 wk (95% confidence interval −1.3, −0.1) shorter and knee-heel length was 4.3 mm smaller (−7.3, −1.3) in infants of 27 mothers with low 25-(OH)D (<28 nmol/liter) at 28–32 wk vs. babies whose mothers had higher concentrations. This latter difference was reduced to −2.7 mm (−5.4, −0.1) after adjustment for gestation length, suggesting some of the apparent growth deficit is explained by shorter gestation. There was no evidence that other birth measures were affected. Maternal PTH concentration at 28–32 wk was positively related to knee-heel length, birth weight, and mid-upper arm and calf circumferences. These associations were independent of 25-(OH)D concentration.

Conclusions: Low maternal 25-(OH)D in late pregnancy is associated with reduced intrauterine long bone growth and slightly shorter gestation. The long-term consequences for linear growth and health require follow-up. The positive relationship between maternal PTH and measures of infant size may relate to increased mineral demands by larger babies, but warrants further investigation.